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(From *Dongyuan*)
Treats hematemesis (vomiting blood) caused by external cold pathogen invasion and internal deficiency with accumulated heat. Li Dongyuan once treated a poor scholar who suffered from Spleen-Stomach deficiency. After taking tonifying medicines, his condition improved, but he subsequently lived in an empty, cold room and slept on a heated kang, leading to coughing and hematemesis. Li Dongyuan stated that this patient had been weak for a long time; living in an empty room in winter with thin clothing further depleted his Yang Qi. There was severe cold on the exterior, which obstructed interior heat, preventing the Fire Pathogen from dispersing, thus causing blood to issue from the mouth. The treatment should tonify the exterior Yang and drain the interior deficiency-heat. Thus, recalling Zhang Zhongjing's treatment of Taiyang disease with floating and tight pulse using Mahuang Tang (Ephedra Decoction):

Formula Composition: Guizhi Twig (Cinnamon Twig, 5 fen) to tonify exterior deficiency; Ephedra Stem (Mahuang, remove exterior cold); Astragalus Root (Huangqi, solidify the exterior and benefit Wei-Qi); Licorice Root (Gancao, roasted) to tonify the Spleen; White Peony Root (Baishao, 1 qian each) to calm the Taiyin; Ginseng Root (Renshen, 3 fen each) to benefit Yuan-Qi and solidify the exterior; Ophiopogon Tuber (Maidong, 3 fen each) to protect Lung Qi; Schisandra Fruit (Wuweizi, 5 grains) to calm Lung Qi.
This formula comprises herbs of the Foot-Taiyang Bladder meridian and the Hand-Foot-Taiyin Lung and Spleen meridians. *Bencao Gangmu* states: "Observing this single prescription, it is sufficient to serve as a model for ten thousand generations." It essentially combines half of Zhang Zhongjing's Mahuang Tang with half of a tonifying formula. For any deficient person requiring Zhang Zhongjing's formulas, this should be taken as the standard.

(From *Jisheng*)
Treats Stomach fire blazing due to Shanghan (cold damage), manifesting as hematemesis, epistaxis (nosebleed), hemoptysis (coughing up blood), hematochezia (blood in stool), sanguineous accumulation with manic behavior, the desire to rinse the mouth without swallowing, and macules caused by Yang toxicity.
(Note: Blood vomited from the mouth is called Tu (hematemesis); blood flowing from the nose is called Nu (epistaxis). Vomiting follows the turbid pathway, while epistaxis follows the clear pathway; the throat and pharynx are two different passages. Blood circulating in the meridians flows freely and does not stay in one place, moving with Qi. Due to the urgency of Fire and Qi, it attacks the clear pathways directly along the meridians, reaching the head and exiting through the nose as epistaxis; if it exits from the Lung orifice through the pharynx, it is hemoptysis or spitting blood; if it comes from the Stomach, it is hematemesis.)

Formula Composition: Rehmannia Root (Shengdihuang, 1.5 liang); White Peony Root (Baishao, 1 liang); Moutan Bark (Danpi); Rhinoceros Horn (Xijiao, 3.5 qian, the tip is especially good. Deer antler velvet is taken for deer, rhino horn tip for rhino, to obtain their essence). If bleeding is caused by anger, add... Jie'an added Angelica Sinensis Root (Danggui), Safflower (Honghua), Platycodon Root (Jiegeng), Tangerine Peel (Chenpi), Licorice Root (Gancao), and Lotus Root Juice (Ou Zhi), named Modified Xijiao Dihuang Tang: treats the same conditions (Angelica Sinensis guides blood back to the vessels; Lotus root juice cools blood and dissipates stasis; Platycodon...).
This formula consists of herbs of the Foot-Yangming Stomach meridian and the Foot-Taiyin Spleen meridian. Blood belongs to Yin and is inherently quiet; however, forced by Fire from various meridians, it loses its position and acts recklessly. Rhinoceros Horn is extremely cold, resolving Stomach heat and clearing Heart fire; White Peony Root is sour and cold, harmonizing Yin-blood and draining Liver fire (the Liver is the mother of the Heart); Moutan Bark is bitter and cold, draining latent fire in the blood; Rehmannia Root is extremely cold, cooling blood and nourishing Kidney water; together they pacify the rebellious Qi of various meridians. (Haizang said: Blood is divided into three parts, and drugs have varying weights. Xijiao Dihuang Tang treats upper bleeding, such as hematemesis and epistaxis; Taoren Chengqi Tang treats middle bleeding, such as blood accumulation in the Middle Jiao with dysentery containing pus and blood; Didang Tang/Wan treats lower bleeding, such as sanguineous accumulation with manic behavior. He also said: This syndrome is governed by the Foot-Taiyin; when the Spleen fails to contain blood, it rebels and moves upward. For excess patterns, use Xijiao Dihuang Tang; for deficiency patterns, use Huangqin Shaoyao Tang. In all cases of vomiting blood, Baishao is used as the primary herb, hence knowing it is a Taiyin medicine. *Yi Guan* states: Xijiao Dihuang Tang is a formula for epistaxis. Rhinoceros is a water animal, capable of dividing water and connecting to heaven. Epistaxis blood travels from the Ren and Du meridians to the vertex, entering the nose. Only Rhinoceros Horn can descend into Kidney Water, guiding the Yin-nourishing properties of Rehmannia up via the Kidney meridian, making it symptomatic. If Yin-deficiency with Fire hyperactivity causes hematemesis or hemoptysis, it may be borrowed for success; however, for Yang-deficiency with laborious cough, or Spleen-Stomach deficiency, it is unsuitable. In Shanghan, incomplete sweating can force blood in the meridians; erroneous sweating also disturbs meridian blood, but these two situations differ. Tao Shangwen treated a patient with Shanghan for four to five days with incessant hematemesis. Physicians treated him with Xijiao Dihuang Tang and Maohua Tang, worsening the condition. Tao palpated the pulse, finding it floating, rapid, and tight, and used Mahuang Tang to induce sweating, resulting in recovery. This prioritizes pulse over symptoms, truly obtaining Zhang Zhongjing's core method. If the pulse were not floating and tight but merely rapid, could it still be used? The Classic states: In Shanghan, if the pulse is floating and tight, and failure to sweat leads to epistaxis, Mahuang Tang governs. It also states: In Taiyang disease, if the pulse is floating and tight, there is fever, no sweating, and spontaneous epistaxis occurs, the disease resolves. Wind-Cold in the meridians stagnates and generates heat; unable to resolve via sweating, epistaxis allows heat to scatter with blood, commonly known as 'red sweat,' thus resolving. If epistaxis occurs without prior sweating, Mahuang must still be used to disperse. Cheng Wuji stated: Epistaxis in Shanghan occurs because pathogens cannot be dispersed, becoming congested in the meridians and forcing blood. Guizhi Tang and Mahuang Tang treat epistaxis not by treating the bleeding itself, but by dispersing pathogens in the meridians. Blood stagnating upward causing hematemesis is called Bojue; blood remaining downward causing stasis is called Xuxue; this arises from Taiyang following the meridians with stagnant heat in the interior, where blood is constrained by heat and knots in the Lower Jiao, causing hardness in the lower abdomen with free urination. Zhu Gong's *Huoren Shu* states that when blood stasis enters the interior causing hematemesis and epistaxis, Xijiao Dihuang Tang is the sacred medicine of the Yangming. If Rhinoceros Horn is unavailable, substitute with Cimicifuga Rhizome (Shengma); however, their nature and flavor are vastly different, how can they substitute? Presumably because Shengma guides other herbs into the Yangming. Zhu Eryun stated: Shengma ascends, while Xijiao descends. Using Xijiao to stop bleeding borrows its descending Qi to clear Heart and Liver fire, causing blood to descend and return to the vessels; if Shengma is mistakenly used, blood will ascend with Qi, leading to unceasing hemorrhage. Therefore, ancient formulas should not be rigidly adhered to.)